1. B I T E W O U N D S
Helena Ruotsalainen

2. F I R S T what animal ( human) ? when cleansing? wash immediately
rabies possible? domestic / wild
tetanus – booster ? 10 – 5 years
surgery necessary?
drugs (pain killers, antibiotics)

3. CAT ( DOG) BITES ( pets) pasteurella multocida ( canis) - pus forming
cat bite more infections than dog bite
hands, foot, face – deep/puncture wounds
symptoms: swollen, red, lymphangitis, pus,
deep to tendons, bone, abscesses, sepsis,
big wounds or only superficial

4. C L E A N S I N G Clean/ tap water, soap water ( rabies)
Sponge away visible dirt
Irrigate with saline, syringe+needle to get under wound edges (but not deep/puncture wounds, penetrating injuries-dirt goes deeper- more complications)

5. T H E R A P Y Elevation ( hands, feet); reduces swelling
Antibiotics: amoxicillin- clavulanic acid, sulfa-trimeth.+ gentamicin( clindamycin)
Surgery? Remove devitalised tissue. No suture older than 8 hours. Wound clousure? Face- because cosmetical problem?
Follow-up 48 hours for infection

6. C A T - S C R A T C H D I S E A S E (CDS)
Bartonella
Skin papule, lymphadenopathy begins after 1-2 weeks, may persist weeks. Overlying skin red, warm, tender
Sometimes general infection ( endocarditis)
If necessary: needle aspiration ( not incision)
Antibiotics may help

7. R A T B I T E S (mice, gerbile)
Streptobacillus ( gr negat.)
Fever, rash, arthritis – no ulceration, no lympahadenopathy
Complications: abscesses, heart, CNS
Therapy: parenteral penicillin
Wear gloves f.ex.at carbage work!

8. S N A K E B I T E S (bees, insect allergy)
Poison: injury to capillaries, vasodilation, defects in blood coagulation)
Swelling, pain, anaphylaxia, anuria
Fluids leak from veins to tissues- hypovolemia, anuria
Therapy: immobilisation, elevation, pain killers, antibiotics,methylprednisolon, tetanus
Suspicion: follow-up 24 hours

9. A N A F Y L A X I A Adrenalin 1mg/ml 0.01ml/kg ad 0.5ml im
Metylprednisolon 2mg/kg iv ad 120mg
H Y P O V O L E M I A: fluids, oxygen
Follow-up: weight, fluids in / out ( urine 2-3
ml/kg/h). After 2-3 days begins recovering:
Fluids back to veins from issues ! Fluid volume –
extra work to heart – possible lungoedema.
Be careful with blood pressure/ weight/fluids /
urine. Furesis may be needeed to get extra fluid out

12. R A B I E S ( v i r u s ) Rapidly progressive CNS manifestations
Dogs:saliva, biting, licking, bats, via air in caves
5 steps: muscle cells-nerve cells-CNS-all over 1) incubation 5days-1 year (ca4-6weeks 2)prodromal symptoms 3) acute neurological 4) coma 5) death during 10 days
Soap wash with brush, alcohol,vaccine, antiserum